Provider Demographics
NPI:1699845701
Name:MEDICI, ROCHELLE (PHD)
Entity type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:
Last Name:MEDICI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 EL MOLINO PL
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-2317
Mailing Address - Country:US
Mailing Address - Phone:626-441-3817
Mailing Address - Fax:626-441-3833
Practice Address - Street 1:2220 EL MOLINO PL
Practice Address - Street 2:
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108-2317
Practice Address - Country:US
Practice Address - Phone:626-441-3817
Practice Address - Fax:626-441-3833
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACP6942103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CP6942Medicare ID - Type Unspecified